Sequential Adjuvant Chemo-Radiotherapy With Vs. Without Erythropoeitin For Patients With High-Risk Cervical Cancer-Second Analysis Of A Prospective, Randomized, Open And Controlled AGO- AND Sequential Adjuvant Chemo-Radiotherapy With Vs. Without Erythropo

Reviewer: Roberto Santiago, MD
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: May 19, 2002

The aim of the study was to compare the disease-free survival achieved by an adjuvant sequential chemoradiotherapy regimen with vs. without Erythropoeitin (EPO) for patients with high-risk cervical cancer

The second endpoints of the study included toxicity, number of transfusions, quality of life, and survival

Materials and Methods

All patients underwent a radical hysterectomy and adjuvant chemotherapy and radiation therapy was recommended postoperatively

EPO arm: EPO 10,000 IU three times a week + oral iron supplements up to a Hb target value of 13 g/dl

No EPO arm: only transfusions were allowed

128 patients from 63 clinics were randomized to each arm between 01/1999 and 03/2001

Results

EPO was given as planned in about half of the patients analyzed in the EPO-arm

The EPO-application was stopped in 33% of patients because a Hb > 14g/dl was achieved

The EPO dose was reduced (10.000 IE/3x/week) in 8% of patients because a Hb > 13 g/dl was achieved

The median doses of carboplatin and ifosphamide (in both arms) were AUC 4 and 1.6 g/m2, respectively

84% of the patients completed the 4 cycles of chemotherapy

Median radiation dose was 50.4 Gy

Median follow-up was 64.5 weeks

There was a significantly higher recurrence-free survival rate in the EPO-arm (89% vs. 78%, p=0.04)

There was a significant reduction of grade 2 anemia (20% vs. 51%, p=0.01) and in the number of red blood cell (no transfusion required: 91% vs. 67%; p=0.0046) as well as platelet transfusions (p=0.0025) in the EPO-arm

Author's Conclusions

Adjuvant sequential chemoradiotherapy with EPO support in patients with high-risk cervical cancer was demonstrated to be easily tolerated and associated to few treatment interruptions

After a short follow-up period, support with EPO appeared to afford a lower rate of recurrences

Clinical/Scientific Implications

It is plausible that the benefit seen is due to re-oxygenation of hypoxic tumors but further research is needed to confirm this hypotesis.

If these findings are confirmed with further follow-up routine EPO support could become a standard component of chemoradiotherapy for cervical cancer.